The workers compensation drug formulary in California is still on track for a Jan. 1, 2018, implementation despite lingering questions regarding opioids.
The California Department of Industrial Relations launched on Sept. 7 another 15-day public comment period for stakeholders to weigh in on minor changes made since the last public comment period ended in early August and does not anticipate more delays, according to a department spokesman.
The open comment period ends Friday, giving regulators a little more than three months to make further changes if warranted and to prepare payers and others for the formulary that will govern how the largest workers comp state prescribes medications for injured workers.
Industry experts say most stakeholders are preparing for the formulary, but are anticipating changes after it is implemented, and that the issue of opioid weaning for legacy claims has not been fully addressed.
“I would be surprised if there weren’t (further changes),” said Lisa Anne Bickford, Sacramento-based director of workers comp government relations for Coventry. “It’s a learning process for all the stakeholders. We tweak things after we find out what works and what doesn’t.”
One of the most controversial elements of California’s proposed comp formulary is that long-term opioid prescribing will no longer be allowed without a review process. Meanwhile, the formulary gives payers and providers until April 1 to come up with a plan for weaning injured workers off opioids who have been prescribed them for some time or continuing such treatments with justifications documented.
Ms. Bickford was among those voicing concerns over opioid weaning during the second public comment period. She stated in a letter that the formulary is unclear on “what actions a claims administrator may take if timeframes are not met. The new rules also lack remedies in other instances.”
In an interview Monday, she said those issues had not been addressed. “It would be great if someone would say to us what specific actions would be taken,” she said. “It’s clearer if it is specified.”
Eddy Canavan, Orange, California-based vice president of the workers compensation practice and compliance for Sedgwick Claims Management Services Inc., said his organization suggested moving the April 1 date to Feb. 1, forcing physicians to sooner provide details on how they will address long-term opioid prescriptions before the current deadline.
“We think it’s too long a period; we know it’s only a two-month (difference) but we are very passionate about getting people off those drugs,” he said, adding that the formulary will require doctors who prescribe long term in workers comp to justify their prescriptions — an element that flags claims.
“With the formulary, knowing who these doctors are and who their patients are, we can laser focus our efforts in a way we have not been able to do in the past,” Mr. Canavan said.
Texas, which introduced its closed formulary in 2011, gave the industry two years to wean injured workers whose doctors could no longer prove they needed stronger pain medications. Many say the stricter timeline, which is not present in California’s formulary, helped curb opioid prescribing in that state.
Time will tell in California, said Mark Pew, senior vice president at Prium, a Duluth, Georgia-based medical cost management firm.
“Some problems with the rules remain,” he said, adding that he believes a tougher legacy claim transition period for those who take opioids would work better for the state but that the formulary, which has already been delayed six months, needs to progress onward.
“We can go back and say, ‘well, you still haven’t fixed that’ but … I think everyone is just ready to finalize the rule so everybody can get busy implementing,” he said.
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